Do you have a strong interest in health insurance and care management? Are you interested in working onsite in a hospital setting, but want to work daylight hours? This opportunity may be a great fit for you! UPMC Health Plan is hiring a full-time Clinical Care Manager supporting our Medical Management group's onsite presence at UPMC Shadyside in Pittsburgh.

In this position, you will be employed through UPMC Health Plan, but will work onsite at UPMC Shadyside and will function as a transition coordinator for UPMC Health Plan Members receiving care at Shadyside.

The position will work standard daylight hours, Monday through Friday.

The Clinical Care Manager is responsible for care coordination and health education with identified Health Plan members through face to face collaboration with members and their caregivers and providers. The Care Manager identifies members medical, behavioral, and social needs and barriers to care, and develops a comprehensive care plan that assists members to close gaps in preventive care. In this role, you will address barriers to care, and support the members self-management of chronic illness based on clinical standards of care.

Additionally, you will collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by face to face interactions in their community including the hospital, providers offices, home, and other health care facilities.

UPMC Health Plan, headquartered in Pittsburgh, Pa., is among the nation's fastest-growing health plans. As part of an integrated health care delivery system, UPMC Health Plan is committed to providing its members better health, more financial security, and the peace of mind they deserve. UPMC Health Plan partners with UPMC and community network providers to produce a combination of knowledge and expertise that provides the highest quality care at the most affordable price. Our local provider network includes UPMC as well as community providers, totaling more than 125 hospitals and more than 11,500 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland.

Responsibilities:

Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care.

Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.

Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.

Document all activities in the Health Plan's care management tracking system following Health

Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.

Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.

Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. Engage members in the Beating the Blues or other education or self management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.

Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.

Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.

Qualifications

Minimum of 2 years of experience in a clinical and/or case management nursing required.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

Do you have a strong interest in health insurance and care management? Are you interested in working onsite in a hospital setting, but want to work daylight hours? This opportunity may be a great fit for you! UPMC Health Plan is hiring a full-time Clinical Care Manager supporting our Medical Management group's onsite presence at UPMC Shadyside in Pittsburgh.

In this position, you will be employed through UPMC Health Plan, but will work onsite at UPMC Shadyside and will function as a transition coordinator for UPMC Health Plan Members receiving care at Shadyside.

The position will work standard daylight hours, Monday through Friday.

The Clinical Care Manager is responsible for care coordination and health education with identified Health Plan members through face to face collaboration with members and their caregivers and providers. The Care Manager identifies members medical, behavioral, and social needs and barriers to care, and develops a comprehensive care plan that assists members to close gaps in preventive care. In this role, you will address barriers to care, and support the members self-management of chronic illness based on clinical standards of care.

Additionally, you will collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by face to face interactions in their community including the hospital, providers offices, home, and other health care facilities.

UPMC Health Plan, headquartered in Pittsburgh, Pa., is among the nation's fastest-growing health plans. As part of an integrated health care delivery system, UPMC Health Plan is committed to providing its members better health, more financial security, and the peace of mind they deserve. UPMC Health Plan partners with UPMC and community network providers to produce a combination of knowledge and expertise that provides the highest quality care at the most affordable price. Our local provider network includes UPMC as well as community providers, totaling more than 125 hospitals and more than 11,500 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland.

Responsibilities:

Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care.

Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.

Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.

Document all activities in the Health Plan's care management tracking system following Health

Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.

Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.

Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. Engage members in the Beating the Blues or other education or self management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.

Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.

Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.

Qualifications

Minimum of 2 years of experience in a clinical and/or case management nursing required.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

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